Prevention of mother to child transmission of HIV

Mother to child transmission is the most common cause of HIV infection in children. A key element of work with under 8 year olds is prevention of mother-to-child transmission in pregnancy, childbirth and infant feeding practices. Key themes focus on access to anti-retroviral drugs (ARVs) during pregnancy and childbirth, if and how to breastfeed, and confusion over unclear messages about infant feeding practices. The World Alliance for Breastfeeding Action is concerned over some of the recommendations put forward by WHO, UNICEF and UNAIDS. For example, using infant formula instead of breastfeeding has been introduced in some resource-poor countries. In this case, babies may not receive the required protection against malnutrition, infection and premature death. Alternative courses of action include exclusive breastfeeding during the first six months, or early cessation of exclusive breastfeeding. This can cause suspicion of HIV leading to stigma. Encouraging women who do not want to change their baby feeding practices can be very difficult

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Selected resources

Books, reports, etc

Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants : guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings

WORLD HEALTH ORGANISATION (WHO)
2004

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Mother to child transmission is the most common cause of HIV infection in children. These guidelines provide updated information on WHO issued recommendations on the use of antiretroviral drugs for preventing mother to child transmission of HIV. These reassessments are within the context of rapidly expanding treatment programmes using simplified and standardised regimens. There has been experienced gained from treatment of mother to child transmission of HIV in resource poor settings as well as further evidence on the safety and effectiveness of various antiretroviral regimens. This document addresses issues of efficacy, safety, drug resistance and feasibility and intends to guide the selection of antiretroviral regimens. They may also be useful for health service providers as specific recommendations are provided for the most frequently encountered clinical situations

Assessing the costs of a rural PMTCT pilot site in the Eastern Cape

DESMOND, Chris
BOYCE, Gerard
Eds
2004

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Mother to child transmission is by far the largest source of HIV infection in children below the age of 15. Prevention of mother to child transmission (PMTCT) programmes have been implemented nationally in South Africa since 2000. This report presents the results of research conducted at a pilot site in the Eastern Cape into the use of resources associated with the implementation of a PMTCT programme. It is part of a larger research project that seeks to examine and compare the costs of providing nevirapine and AZT in both urban and rural contexts. It is hoped that this study will contribute to the national programme of monitoring and evaluating the costs and effectiveness of PMTCT interventions in South Africa

Community care, change and hope : local responses to HIV in Zambia

LUCAS, Sue
2004

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This case study documents a successful model for facilitating a strong community response to HIV and AIDS. The Salvation Army Change Programme in Ndola and Choma Districts in Zambia illustrates the facilitation process stimulating an appropriate local response to HIV and AIDS and essential component of human capacity development. The model builds on local strengths and resources, stimulating ordinary people to address the barriers that prevent them from using HIV and AIDS information and services to prevent new infections, compassionately care for those who are infected and mitigate the effects of the epidemic on families and the community. Only by addressing personal risk, stigma and the potential for personal and societal change will the demand for and use of voluntary counselling and testing, prevention of mother to child transmission and antiretroviral therapy services increase

Great expectations

WORLD HEALTH ORGANISATION (WHO)
November 2004

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The subject of World Health Day 2005 is maternal and child health. In the lead up to World Health Day on 7 April 2005, six mothers-to-be living in different countries of the world are sharing their experiences of pregnancy and childbirth. The six unique stories reflect a common theme, the central importance of child health to families, communities and societies and aim to raise awareness of the challenges faced on a global level in improving maternal and newborn health

HIV and infant feeding : a compilation of programmatic evidence

KONIZ-BOOHER, Peggy
et al
July 2004

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This paper tries to deepen understandings of the biological and programmatic implications of the transmission of HIV through breastfeeding which have previously been hampered by insufficient study and difficulties of interpretation. It is a careful look at the findings of programmatic approaches. The project attempted to find, summarise and analyse reports on a wide variety of relevant programmes conducted since 1998 UNICEF guidelines were issued. The programmes range from small community research projects to national programmes. The compilation addresses numerous controversial topics and constraints, including human resources, confused mothers, stigma and discrimination, spillover of replacement feeding, free or subsidised infant formula, family economics and the difficulty in providing integrated HIV testing, informed choice counselling, community support, logistics and follow-up care for mothers and infants

HIV and infant feeding : a report of a WABA-UNICEF Colloquium

GREINER, Ted
Ed
2003

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This report covers the main dilemmas and debates around HIV/AIDS and infant feeding practices. There is some focus on antiretrovirals and prevention of mother to child transmission, but sessions featured in the report mainly cover technical and progammatic issues, and the sharing of field experiences. The key themes are the issues of if and how to breastfeed, and confusion over unclear messages about infant feeding practices. Increasing access to information and voluntary counselling and testing is covered as well as community involvement and the perspective and role of breastfeeding supportive NGOs. Lessons learned are drawn upon and details of each working group on various subjects are documented. Research, monitoring and evaluation priorities are looked at, and there is a presentation of knowledge gaps and challenges for the future

HIV risk exposure in young children : a study of 2-9 year olds served by public health facilities in the Free State, South Africa

SHISANA, Olive
MEHTAR, Shaheen
2005

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South Africa has, until now, focused its HIV prevention efforts on youth and adults, and now needs to expand its focus to include children. Much is already known about mother to child transmission, which is the dominant mode of HIV transmission among children. However, little investigation has been done into the potential for horizontal transmission of HIV on the population below reproductive age. This report focuses on children aged 2-9 years and, using a combination of qualitative and quantitative methods, presents evidence on the potential for HIV transmission in dental, maternity and paediatric service in public health facilities. A new finding concerns the practice of shared breastfeeding

HIV-infected women and their families : psychosocial support and related issues. A literature review

LINDSEY, Elizabeth
2003

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This review looks at global literature from academic institutions and UN agencies on psychosocial support and counselling, to HIV infected pregnant women and their families (from pre-conception to 2 years old). It also contains information about the efficacy of practices and projects that care for infected women and their families, especially methods used in relation to mother-to-child transmission during the perinatal period. There are also interesting examples of such projects from around the world. The final section of the review makes recommendations on psychosocial support and counselling for HIV infected women and families

Improving nutrition and reproductive health : a review of UNICEF experience with the distribution of free infant formula for infants of HIV-infected mothers in Africa

WAGT, Arjan de
Clark, David
2004

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This review considers the experience of UNICEF with the distribution of free infant formula for infants of HIV infected mothers in Africa. UNICEF has provided, or is planning to provide, support to pregnant women in 54 countries, with HIV testing and counselling, improved health care, anti-retroviral drugs, and counselling on infant feeding options. After 1998, UNICEF decided to provide poorer HIV positive mothers with an alternative to breastfeeding by providing free formula. This paper presents the experiences with the procurement, distribution and use of free formula in PMTCT programmes. It further suggests conditions for the use of free formula

Placental malaria increases mother to child HIV transmission

BRAHMBHATT, Heena
November 2003

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This news release from John Hopkins University contains reports that that placental malaria infection during pregnancy scientifically increases the risk of mother-to-child transmission of HIV. The study, funded by John Hopkins University, was carried out in Uganda where 40% of HIV positive women with placental malaria had HIV positive babies, compared to 15.4% of HIV positive women without malaria. Interventions to prevent malaria during pregnancy could potentially reduce mother-to-child transmission of HIV

WABA position on HIV and breastfeeding

WORLD ALLIANCE FOR BREASTFEEDING ACTION (WABA)
1998

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This is a position paper on HIV and breastfeeding. It makes broad statements on the situation of breastfeeding mothers in the light of HIV. It states that it is concerned that recent changes in WHO, UNICEF and UNAIDS policy regarding breastfeeding and HIV as these changes appear to put major stress on the use of infant formula and less on alternative feeding methods. Recommendations are then made which indicate what some of these alternatives are

Journal articles

HIV/AIDS and early childhood [whole issue]

BARTLETT, Kathy
ZIMANYI, Louise
Eds
December 2002

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This is one of the few publications solely dedicated to early childhood and HIV/AIDS. It contains articles examining the particular experience of the very young child and the social, psychosocial and nutritional impact on their lives in AIDS affected communities. There is also an article about infant feeding practices in Africa. It makes some policy recommendations and the several case studies provide some direct examples of programming in this area

Multimedia

Integrating food and nutrition into HIV and AIDS strategies

MCDERMOTT, Peter
2005

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This is a slide presentation which considers the role of food and nutrition in the context of HIV and AIDS. It notes the vicious cycle of malnutrition, HIV and poverty and the effects of HIV and AIDS on nutrition, household food security and food production. HIV and AIDS also have an impact on the agricultural sector and examples are shown from Kenya, Zambia and Malawi. Increased malnutrition can lead to adults needing more access to quality health care but not getting it, increased caring for sick adults means less time for childcare, and children drop out of school to help with household labour. Finally, UNICEF support to nutrition and HIV and AIDS is shown along with their current operational approach. The Food and Agriculture Organization (FAO) and World Food Program (WFP) approach is also considered

Websites

HIV and infant feeding

WORLD ALLIANCE FOR BREASTFEEDING ACTION (WABA)

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This section of WABA's website provides resources and information on key issues such as what interventions should be put in place to prevent transmission of HIV through breastfeeding, while also protecting, promoting and supporting breastfeeding for the majority of children who benefit from it. It also tries to address the question of how to decide which children would be at greater risk from being breastfed. An additional difficulty is the need to encourage HIV-positive mothers to choose either exclusive replacement feeding or exclusive breastfeeding, since neither is common in low-income populations

Women, children, and HIV

FRANCOIS XAVIER BAGNAUD (FXB) CENTER
CENTER FOR HIV INFORMATION (CHI)

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This site contains a library of practically applicable materials on mother and child HIV infection including preventing mother-to-child HIV transmission (PMTCT), infant feeding, clinical care of women and children living with HIV infection, and the support of orphans. The goal of the site is to contribute to an improvement in the scale and quality of international HIV/AIDS prevention, care, and treatment programs for women and children by increasing access to authoritative HIV/AIDS information. Its aims are to disseminate state of the art clinical information and training resources on MTCT and related topics. It also communicates the best practices in preventing MTCT and caring for infected children. It aims to disseminate prevention of MTCT program resource materials, clinical information and training resources on perinatally acquired pediatric HIV infection. It is browseable and searchable through a basic 'free-text' search box. The site also features an up-to-date news section.